In the work The skills of the psychotherapistWilliam R. Miller and Theresa B. Moyers highlight an often underestimated factor: the decisive role of the clinician himself. Questions to Emeric Languérand, psychologist and French translator of the work.
How was this work born?
The skills of the psychotherapist (translation of Effective Psychotherapists by William R. Miller and Theresa B. Moyers) is part of an old trajectory, which dates back to the beginnings of the career of William R. Miller (1) in the 1970s. Initially trained in a context dominated by behavioral approaches, he discovered the work of Carl Rogers almost by chance, through the teaching of Sue Gilmore. This meeting will be decisive. He will measure it directly in his first clinical experiences, particularly in alcoholology where, due to a lack of specific tools, he mobilizes Rogerian skills to enter into relationships with patients.
Very quickly, a tension seems to emerge between two models:
- Structured techniques aimed at changing behavior
- A person-centered approach, emphasizing the quality of the relationship.
This tension is actually more apparent than real. Miller observed how effective behavioral therapists demonstrated interpersonal skills that went well beyond the application of any one technique.
It is in this context that a central question emerges: what, in the therapist’s practice, really promotes change? A first observation is then necessary: the nature of the intervention alone is not enough to answer the question. Miller’s early empirical research reveals that, with equal techniques, results vary greatly between therapists, particularly according to their level of empathy. This question gives rise to motivational interviewing. Then, later, it was this work (The skills of the psychotherapist) which sees the light of day, constituting a form of reflective feedback on all of this work.
What does the “therapist effect” consist of in the therapeutic process?
The “therapist effect” refers to all the factors linked to the clinician which influence the effectiveness of psychotherapy, independently of the method used. This is a phenomenon documented for several decades which shows that differences in effectiveness between two therapists applying the same techniques are mainly associated with the relational skills of the practitioner. As has been highlighted in work on motivational interviewing, the therapist’s attitude directly influences the patient’s internal processes, including his or her commitment to change. Obviously, perceived empathy, the quality of reflective listening or even non-confrontational positioning contribute to creating a climate conducive to the exploration and resolution of ambivalence. However, beyond these known skills, William R. Miller and Theresa B. Moyers also emphasize the skills of acceptance, unconditional positive regard, authenticity, focus, evocation or even those promoting hopes and expectations with regard to therapy.
Conversely, certain attitudes – confrontation, excessive directness, lack of adjustment – can generate reactions of resistance, of “discordance”, that is to say interpersonal phenomena which hinder the therapeutic process to the point of making it deleterious. This work thus undermines the commonplace which postulates the non-harmfulness of psychotherapeutic intervention. The authors highlight, with supporting evidence, how the absence of interpersonal skills can be harmful to the patient’s health.
The “therapist effect” is therefore not limited to empathic know-how: it involves an ability to mobilize specific relational skills to activate therapeutic processes.
How do you acquire the essential skills to become a truly effective therapist?
One of the major contributions of this work is to show that these skills are neither a personality trait nor an innate talent, but a matter of structured learning.
However, theoretical training alone is insufficient. The data is clear: participating in training can give the feeling of having acquired a skill, without it actually being integrated into practice. The issue is therefore that of deliberate practice: targeted, progressive training, focused on specific skills.
This process relies on several levers:
- Observation of one’s practice, particularly from recordings;
- The feedback external (feedback), particularly in supervision;
- Iterative work on targeted skills;
- The ability to adjust interventions based on patient reactions.
In this regard, the development of the therapist’s skills can be compared to that of other complex expertise: like a musician or an athlete, the clinician progresses through training, correction and repetition. This perspective is developed in the preface to the French edition of the work, where the therapist’s journey is considered as a developmental process.
How is this work structured?
The work is organized into three main parts. The first is devoted to highlighting the “therapist effect” and its importance in the effectiveness of interventions, beyond theoretical models.
The second part constitutes the heart of the work: it describes the different skills of the psychotherapist. Each chapter is structured systematically, with a precise definition of competence, its distinction from personal qualities, its implementation methods, clinical examples and a state of scientific knowledge.
Finally, the third part is dedicated to the development of skills presented in the previous part. It addresses the conditions for their acquisition, the role of supervision and the need to integrate these dimensions in the evaluation of professional practices.
Who is this book for?
This work is of course aimed at psychotherapists – psychologists, psychiatrists – but its scope is broader. It concerns all professionals engaged in a care or assistance relationship: nurses, advanced practice nurses (APNs), social workers, educators and even doctors.
In this regard, it particularly resonates with nursing training, the DNA of which is historically based on the work of Carl Rogers. Indeed, if Rogerian principles are often present in initial training, this work allows us to go further by placing them in an empirical and operational perspective: it is no longer just a question of “knowing how to be”, but of understanding how these skills concretely influence change processes and how to develop them in a structured way.
Beyond psychotherapy, this work therefore offers a transversal reflection on the helping relationship: how to effectively support a person in a therapeutic process, by articulating relational skills and intervention strategies.
1– Emeritus professor of psychology and psychiatry, known for his research in addictionology. He is notably at the origin of motivational interviewing (MI), a relational practice promoting autonomy. MI can be effective in supporting motivation to change in patients with various psychological disorders.
• Miller W. R., Moyers T. B., trad. fr. d’Emeric Languérand, The skills of the psychotherapistEd. Inter éditions, coll. Care and Psy, March 2026, €34.00